Tear system, or the lacrimal system has two main components. The secretory system which produces tears and the discharging system that cleans the tears from the eye after its job is done. In the secretory system the tear is produced and delivered to the eye surface. After tears get their job done on the eye, they are flowed to the nose without our notice.
Why is the lacrimal duct obstructed on children?
Before talking about lacrimal duct obstruction, the anatomy of the discharging system should be discussed to make the subject clearer. When we slightly lift our eyelids and look into the mirror, we see a tiny hole where lower and upper eyelids are near the nose. These holes are called as punctum and they are the beginning end of the discharging system. When tear are done with their duties on eye, they are flowed to these holes with the help of a pump. The tears that go through this hole are transmitted to the lacrimal sac with the help of a canal called canaliculi and gathered there. After tears come to the lacrimal sac, they flow through a canal called nasolacrimal canal which is kind of a continuation of the lacrimal sac and they are delivered to the nose. There is a valve in between nasolacrimal canal and nose.
Now, we can return to our subject after this general information. How does lacrimal duct obstruction occur?
The valve that is in between nasolacrimal canal and nose can be obstructed on some kids when these structures cannot complete their development. So, when this valve is obstructed, tears cannot flow to the nose and they pile up in the sac. Then, they watch a backwards flow and pile up in the eye and of course it flows through the lids and the eyes start watering.
Can we detect lacrymal duct obstruction?
Yes, careful parents can detect it easily. Because since the tears don’t flow to the nose, it must always flow outside and this results with constant watering..
Are all watering eyes lacrymal duct obstruction?
The answer to this question is of course no. Because there many reasons that can cause watering like eye infection, eye allergies or foreign body in the eye. However, inherent watering and burring from time to time on kids are usual signs of lacrimal duct obstruction.
Can constant watering harm my child’s eye?
This question can be answered like this: We can liken the tear discharging system to a river bottom. When a river bottom is closed, there will be backwards water accumulation and lots of brushwood will be gathered. One of tears’ duty is to wash and clean our eyes They clean the dust, foreign objects and microbes that enter our eyes during the day and deliver them to the discharging system. Then, when the lacrimal canal system is obstructed, this dirt stay inside tears and makes the eye germ infested. So, these germs might cause lots of different infections on the eye like conjunctivitis or keratitis.
Can the lacrymal canal open on its own?
The duct opens up on the 70-80% of the kids that was born with an obstructed lacrimal duct in the first month.
What Should I Do If It Is Not Opened?
You should of course see an ophthalmologist. Your ophthalmologist will recommend you some eyedrops and gels. He or she could also recommend and show you some massage techniques to help open the lacrimal duct.
Should It Be Done If the Duct Is Still Not Opened After the Treatment?
If despite the massage and treatment the duct is not opened, we do the surgical operation called probing. With this probe technique the duct will be opened 95% and the problem will be solved. There is a 5% chance that lacrimal duct will be obstructed again. In that case, a second probing should be done. If it gets obstructed again after the second probing, then the second option of lacrimal intubation must be done. In lacrimal intubation, a silicone tube is placed in the lacrimal duct so that it does not get obstructed. About 3 months later, this tube is taken out and the openness of the duct is preserved. However, sometimes even after taking out the tube, the dust might get obstructed. In this situation, our last option is an open surgical operation called DSR (Dacryocystorhinostomy) in which a new duct is built.
Can the probing surgery be held up?
Like I discussed above, around the age of one is the appropriate time for the surgery. After this age however long the surgery is put off, the chances of the surgery’s success decreases accordingly.